Background
Methods
Patients and study design
Triage SOP based on the LAMS instrument
Endpoints
Geocoding
Ethical aspects
Statistical analyses
Results
Demographic and medical characteristics
Triage decision | Transport destinationa | ||||
---|---|---|---|---|---|
Total (n = 1123) | CSC (n = 188) | PSC (n = 935) | CSC (n = 424) | PSC (n = 699) | |
Demographic and prehospital data | |||||
Age, years; median (IQR) | 78 (68–85) | 74 (66–83) | 79 (68–85) | 76 (66–84) | 80 (69–85) |
Male sex, n (%) | 565 (50.3) | 97 (51.6) | 468 (50.1) | 218 (51.4) | 347 (49.6) |
Symptom onset to call, min; median (IQR) | 55 (11–353) | 19 (6–126) | 68 (14–406) | 36 (8–233) | 74 (15–426) |
LAMS, n/total n (%) | |||||
LAMS< 4 | 855/1123 (80.4) | 49/855 (5.7) | 806/855 (94.3) | 269/855 (31.5) | 586/855 (68.5) |
LAMS≥4 | 208/1123 (19.6) | 135/208 (64.9) | 73/208 (35.1) | 140/208 (67.3) | 68/208 (32.7) |
NIHSS admission, median (IQR) | |||||
All | 4 (1–8) | 10 (5–17) | 3 (1–6) | 5 (2–11) | 3 (1–6) |
Patients with strokes | 4 (2–8) | 8 (5–16) | 3 (1–6) | 5 (2–10) | 3 (1–6) |
Discharge diagnoses, n (%) | |||||
Ischaemic stroke | 644 (57.3) | 119 (63.3) | 525 (56.1) | 254 (59.9) | 390 (55.8) |
LVO stroke | 78 (6.9) | 54 (28.7) | 24 (2.6) | 58 (13.7) | 20 (2.9) |
Intracranial haemorrhage | 84 (7.5) | 28 (14.9) | 45 (4.8) | 56 (13.2) | 39 (5.6) |
Stroke mimics | 395 (35.2) | 41 (21.8) | 354 (37.9) | 125 (29.5) | 270 (38.6) |
Epileptic seizure | 85 (7.6) | 21 (11.2) | 64 (6.8) | 38 (9.0) | 47 (6.7) |
Migraine | 11 (1.0) | 1 (0.5) | 11 (1.2) | 3 (0.7) | 8 (1.1) |
Vestibulopathy | 31 (2.8) | 0 | 31 (3.3) | 9 (2.1) | 22 (3.1) |
Infection | 52 (4.6) | 4 (2.1) | 48 (5.1) | 19 (4. 5) | 33 (4.7) |
Exsiccosis | 17 (1.5) | 0 | 17 (1.8) | 4 (0.9) | 13 (1.9) |
Delirium | 31 (2.8) | 0 | 31 (3.3) | 8 (1.9) | 23 (3.3) |
Hypertensive crisis | 6 (0.5) | 1 (0.5) | 5 (0.5) | 2 (0.5) | 4 (0.6) |
Peripheral facial palsy | 11 (1.0) | 0 | 11 (1.2) | 6 (1.4) | 5 (0.7) |
Intoxication | 6 (0.5) | 1 (0.5) | 5 (0.5) | 2 (0.5) | 4 (0.6) |
Syncope | 18 (1.6) | 1 (0.5) | 17 (1.8) | 4 (0.9) | 14 (2.0) |
Other | 86 (7.7) | 12 (6.4) | 74 (7.9) | 31 (7.3) | 55 (7.9) |
Feasibility and performance of the LAMS-based triage SOP in triage of stroke patients
Triage SOP (n = 968) | Modelled conventional careb (n = 968) | |
---|---|---|
LVO, n/total n (%) | ||
Sensitivity | 54/78 (69.2; 59.0–79.5) | 14/78 (17.9; 9.4–26.5) |
Specificity | 756/890 (84.9; 82.6–87.3) | 890/890 (100; 100–100) |
Positive Predictive Value | 54/188 (28.7; 22.3–35.2) | 14/14 (100; 100–100) |
Negative Predictive Value | 756/780 (96.9; 95.7–98.1) | 890/954 (93.3; 91.7–94.9) |
LVO or ICH, n/total n (%) | ||
Sensitivity | 82/162 (50.6; 42.9–58.3) | 38/162 (23.5; 16.9–30.0) |
Specificity | 700/806 (86.8; 84.5–89.2) | 806/806 (100; 100–100) |
Positive Predictive Value | 82/188 (43.6; 36.5–50.7) | 38/38 (100; 100–100) |
Negative Predictive Value | 700/780 (89.7; 87.6–91.9) | 806/930 (86.7; 84.5–88.9) |
Performance of the LAMS in identifying LVO
All patientsa (n = 920) | Patients with strokeb (n = 547) | |||
---|---|---|---|---|
Variable, n/total n (%) | LVO | LVO or ICH | LVO | LVO or ICH |
Sensitivity | 52/77 (67.5; 57.1–78.0) | 90/159 (56.6; 48.9–64.3) | 52/77 (67.5; 57.1–78.0) | 90/158 (57.0; 49.2–64.7) |
Specificity | 704/843 (83.5; 81.0–86.0) | 660/761 (86.7; 84.3–89.1) | 366/470 (77.9; 74.1–81.6) | 323/389 (83.0; 79.3–86.8) |
Positive predictive value | 52/191 (27.2; 20.9–33.5) | 90/191 (47.1; 40.0–54.2) | 52/156 (33.3; 25.9–40.7) | 90/156 (57.7; 49.9–65.4) |
Negative predictive value | 704/729 (96.6; 95.3–97.9) | 660/729 (90.5; 88.4–92.7) | 366/391 (93.6; 91.2–96.0) | 323/391 (82.6; 78.9–86.4) |
Stroke management metrics and short-term outcomes
Total (n = 1077) | CSC (n = 400) | PSC (n = 677) | p-value | |
---|---|---|---|---|
Stroke-management metrics, min; median (IQR) | ||||
Time from call to | ||||
On-scene | 10 (8–13) | 9 (7–12) | 10 (8–13) | 0.105 |
Doora | 49 (41–59) | 51 (41–61) | 48 (40–59) | 0.008 |
First contact to neurologist | 51 (42–62) | 51 (42–62) | 52 (43–62) | 0.739 |
Non-contrast imaging | 75 (60–99) | 73 (58–104) | 76 (62–96) | 0.698 |
Initial vascular imaging | 75 (62–99) | 74 (60–99) | 76 (64–98) | 0.005 |
Needle | 87 (67–100) | 93 (73–103) | 79 (66–95) | 0.017 |
Groin puncture | 112 (95–135) | 105 (88–121) | 292 (230–515) | < 0.001 |
Time from door to | ||||
Non-contrast imaging | 23 (13–42) | 18 (11–43) | 26 (16–40) | < 0.001 |
Initial vascular imaging | 21 (15–38) | 19 (14–33) | 27 (20–42) | < 0.001 |
Needle | 35 (27–49) | 40 (29–50) | 32 (26–48) | 0.054 |
Groin puncture | 57 (48–85) | 53 (47–74) | 233 (172–446) | < 0.001 |